How to check for prostate cancer

One in eight men is affected by prostate cancer, so it’s understandable to be concerned about it. However, unlike breast cancer, where there is a national screening programme and often a tell-tale symptom such as a lump, it’s not so easy to check yourself for prostate cancer.

This blog will help you to understand what you can do to check for prostate cancer, the tests and exams that are used, and when and how to get them.

Firstly, there are two basic tests which, if you go to your GP, they’re likely to do if they suspect or want to rule out prostate cancer:

• A PSA test
• A digital rectal examination (DRE)

A PSA test is a blood test that looks at the levels of a type of protein called prostate specific antigen that’s circulating in your body. PSA is produced by normal cells in your prostate and also by cancerous cells, although sometimes the cancerous cells produce more. A high PSA level could be a sign of prostate cancer.

However, it’s not that simple. All men have some PSA in their blood and the amount they have can vary from one person to another. And in general, the older you are, the more PSA you naturally produce. There are other factors that can also cause your PSA levels to rise, such as a condition called prostatitis. It can even chnage from day-to-day and effect a test result due to:

• Ejaculation in the last 48 hours
• Having a digital rectal exam before the blood test
• Vigorous exercise 48 hours before the blood test
• A prostate biopsy within the previous 6 weeks

To complicate things further, it’s possible to be diagnosed with prostate cancer and yet have a PSA level within the normal range.

Taken together this means that a high PSA can be an indicator of a prostate problem, but it won’t be used on its own to diagnose prostate cancer. In fact, the uncertainty of the PSA test on its own is the reason why it wasn’t adopted as a national screening programme for prostate cancer. Without taking account of other possible factors, a high PSA test might just lead you down a road of unnecessary investigations that might have a negative impact on your health and wellbeing. Often, a GP will keep an eye on your PSA reading and look for changes over time as a sign that it’s time to consider further tests, such as an MRI scan.

If you want to do a prostate cancer check yourself, you may be tempted to buy an online PSA testing kit – some of these look for levels of bound and free PSA in your blood, although this isn’t used to diagnose prostate cancer. The best advice is to go to your doctor or see a private urologist for prostate assessment and PSA test. Here, we can look at a number of other things, not just your PSA reading.

Given that PSA isn’t enough on its own, a GP may carry out other prostate checks – like a prostate examination.

A digital rectal examination (DRE) is carried out to feel for any changes in your prostate using a finger (digit) inside your bottom. Due to the location of the prostate, anyone wondering ‘can you check our own prostate?’ should realise that this is simply not possible. The prostate is tucked away between the bladder and the rectum. A doctor or nurse will examine you while you’re lying on your side with your knees up.

Don’t be put off by a few moments of awkwardness – a rectal exam often provides a very useful indicator of a prostate problem. If it’s enlarged, it can be a sign of benign prostate hyperplasia (BHP), a common cause of prostate problems in older men but not a serious condition. However, if it feels hard and lumpy, that might be a sign of prostate cancer. In that case, your doctor may recommend a biopsy to take a small piece of prostate to look at under a microscope for changes in cells that signal cancer.

Before any of these tests, a doctor will ask you questions about your medical history and decide if you’re in a group of men that’s more at risk of getting prostate cancer. These ‘risk factors’ include:

• Age: Prostate cancer is more common as you get older and is in fact most common in men aged 75-79 years. Men often ask what age they should have a prostate exam? Prostate Cancer UK suggest that any men over the age of 50 should be given a PSA test if they ask their GP for one. If you’re in your 30s or 40s, you shouldn’t be worried unless you’re in another high-risk group or you have some other symptoms.
• History: If a close family member, such as your brother or father, also had prostate cancer you might be at risk. Also, some families carry a gene called the BRCA2 gene – more commonly associated with an increased risk of breast and ovarian cancer in women. Any men in the family with this gene could be up to 5 times more likely to develop prostate cancer.
• Ethnicity: Prostate cancer is more common in black Caribbean and black African men – in fact one in four may develop it compared with one in eight in the average male population. Conversely, men of Asian origin are less likely to get it.
• Weight: As with so many other health problems, having a BMI (body mass index) of 25-30 (overweight) or more than 30 (obese) puts you at higher risk of prostate cancer. If you’re worried about cancer, it’s perhaps a good time to think about losing some weight – so talk to your doctor and they’ll be happy to help.

There are various other causes, such as rare conditions, as well as some unproven claims that show links between height, vasectomy and prostatitis (inflamed prostate), but medical science has not shown any clear evidence of these links. As ever, the advice is not to believe everything you read in the news, and if you’re not sure, ask your doctor.

Often there are very few signs of prostate cancer, and they can be confused with symptoms of other prostate problems. Some men may experience difficulty passing urine (weeing), such as slow starting, a weak flow, a sudden urge to wee and getting up more frequently in the night. But especially in older men, these can often be due to enlarged prostate symptoms – where the prostate presses against the bladder and the urethra (the tube that empties from the bladder) and affects the flow of urine.

Prostate cancer is slightly different. Usually it grows around the outside of the prostate and doesn’t really make the prostate gland bigger in the early stage so doesn’t press on the bladder or urethra. However, you can have both BPH and prostate cancer at once – so your doctor will want to check it out to be sure.

The prostate is a small gland and its role in life is to secrete fluids into semen to keep sperm in tip top condition. It is tucked between the bladder and the rectum (back passage) and gradually gets larger as you age.

Pain and difficulty passing urine can frequently be caused by prostatitis, a bacterial infection causing swelling and pain. A urine infection can also often be a cause of troublesome symptoms, particularly in older men. A GP will usually check for an infection early on, but may suggest a prostate cancer check at the same time, usually just to rule it out.

Other signs of a problem include blood in your urine or semen or pain in your testicles, back, pelvis or hip, and unexplained weight loss. Anyone with these symptoms should book an appointment with a doctor or urology clinic as soon as possible.

Finally, with any symptoms, it’s important and helpful to keep a note of them – when they started, how frequently they occur and how much they affect your daily life – so you can share this with a doctor when it’s time to get them checked.

Although you can’t check yourself for prostate cancer, you should be aware of your risk factor, keep an eye out for any symptoms and be prepared to ask for a prostate test if you’re at all concerned. You can ask your GP or go to a urology clinic. Prostate cancer is the most common cancer in men in the UK, and although more people are being diagnosed, it’s mainly because they’re more aware and going to get symptoms checked – which is good news, because early diagnosis can lead to better outcomes.

If you’d like to arrange a prostate cancer check privately, we run specialist clinics where you can have a PSA test, prostate examination and discuss your concerns with a consultant. Even if you don’t have prostate cancer symptoms but feel you may be at risk and want the peace of mind, we welcome you to our clinics. You can use your medical insurance or we have self-pay prices.

Find out more about our private prostate cancer screening service